PRIMER ON SLEEP & HEALTHMICHEL A. CRAMER BORNEMANN, MD, DABMS-SM, FAASM

LEAD INVESTIGATOR- SLEEP FORENSICS ASSOCIATES VISITING PROFESSOR- SLEEP MEDICINE FELLOWSHIP, MRSDC, HCMC

Primer on Sleep & Health

Objectives:

1. Appreciate that sleep is an evolutionary imperative built for survival

2. Review normal sleep process and determinants of sleep

3. Understand why sleep is important to health

4. Review spectrum of Sleep Disorders

Average Daily SLEEP Totals Across Animal Species

Sleep Requirements for Humans Across Ages

“SLEEP IS AN ACT THAT HAS BEEN PROGRAMMED WITH KARMIC INEVITABILITY,

INTO THE HUMAN SYSTEM, AND NO ONE CAN DIVERGE FROM IT…”

HARUKI MURAKAMI

Determinants of SleepSleep is Regulated by Two Body Systems:

1. Homeostatic Drive- Sleep/Wake Restorative Process which balance Sleep and Wakefulness

2. Biological Clock/Circadian Rhythm- Regulates Timing of Sleep and Wakefulness

The Influence of Circadian Rhythm is Broad

Sleep Process Cycles of Sleep

1.The study of sleep involves nocturnal polysomnography (PSG)

2. A PSG involves the monitoring the following variables:

1.Electroencephalography (EEG)

2.Electooculogram (EOG)

3.Electromyography (EMG)

4.Electrocardiogram (EKG)

5.Hemoglobin O2 Saturation (SaO2)

6.Position

7.Soun

Sleep Process Cycles of Sleep

1.The study of sleep involves nocturnal polysomnography (PSG)

2. A PSG involves the monitoring the following variables:

1.Electroencephalography (EEG)

2.Electooculogram (EOG)

3.Electromyography (EMG)

4.Electrocardiogram (EKG)

5.Hemoglobin O2 Saturation (SaO2)

6.Position

7.Sound

Sleep Process Cycles of Sleep

Here is what a typical sleep cycle and a night of sleep looks like…

Cycle 1 Cycle 2 Cycle 3 Cycle 4-5

Physiologic VariablesNREM REM

Heart Rate Regular IRREGULAR

Respiratory Rate Regular IRREGULAR

Blood Pressure Regular Variable

Skeletal Muscle Tone Preserved ABSENTBrain O2 Consumption Reduced INCREASED

Response to CO2 same as wake Depressed

Response to O2 same as wake same as wakeTemperature Regulation Homeothermic Poikilothermic

Penile Tumescence Infrequent FREQUENT

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Here is what a typical sleep cycle and a night of sleep looks like…

Physiologic VariablesNREM REM

Heart Rate Regular IRREGULAR

Respiratory Rate Regular IRREGULAR

Blood Pressure Regular Variable

Skeletal Muscle Tone Preserved ABSENTBrain O2 Consumption Reduced INCREASED

Response to CO2 same as wake Depressed

Response to O2 same as wake same as wakeTemperature Regulation Homeothermic Poikilothermic

Penile Tumescence Infrequent FREQUENT

Here is what a typical sleep cycle and a night of sleep looks like…

Physiologic VariablesNREM REM

HHHHHHHHHHHHHHHHHHHHHHHHHHHHHeeeeeeeeeeeeeeeeeeeeeartttttttttttt RRRRRRRRRRRRRRRRRRaaaaattttttteee Regular IRREGULAR

RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRReeeeeeeeeeeeeeeespiiiiiiiiiiiirrrrrrrrrrrrrrrrrrrrrrrraaaaaaaaaaaaaaaaaaaaaaaaaatttttttttttttttttttttoooooooooooooooooooooooryyyyyyyyyyyy RRRRRRatttttttte Reggggggggggggggggggggggular IRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRREGULAR

BBBBBBBBBBBBBBBBlllllooooood Presssssssssssssssssssuuuuuuuure RRRRRRRRRegggggggullarrrrrrrr VVVVVVVVaaaaaaaaaariaaaabbbbbbbbbbbbbbbbbbbbbbbblllllllleeeeeeeeeeeeeeee

Skeletal Muuuuuuusssssscccccccle TTToooooooonee PPPPPPPPPrreeeeeeeesseerrrrrrrrrveeeeeeeeedd AAAAAAAAABBBBBBBBBBSEEEENNNNNNNTTTTTTTTBrain O2 CCCCCCCCCCCCCCCCCCCCCConoooooo susuuumppppppppppppptionononoo RRRRRRRRRRRRRRRRRRRRRedddddddddddddddddddduuuuuuuuuuuuceddddddddddddddddddd IIIINNNNNNNNNNNNNNNCCCCCCCCCCCCCCCCCCCCCCRRRRRRRRRRRREEEEEEEEEEEEEEEEEEEEAAAAAAAAAAAAAAAAAAAAAAAAAAASSSSSSSEEEEEEEEEEEEEEEEEEEEEEEEEEEEDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD

Response to CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCO2 sssssssssssssssssaaaaaaaaaaaaaaaaaaaaaaammmmmmmmmmmmmmmmmmmmeeeeeeeeeeeeeeeeeeeeeeeeeeeee aaaaaaaaaaaaaaaaaaaaaas wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwakkkkkkkkkkkkkkkkkkkkkkeeeeeeeeeeeeeeeeeeeeeee DDDDDDDDDDDDDDDDDDDDDeppppppppppppppppppppppppppppprrrrrrrrrrrrrrrrrrrrrrrrrrreeeeeeessssssssssssssssssssssssseeeeeeeeeeeeeeeeeeeeeeeed

Response to OOOOOOOOOOOOOOO2 same as wakkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkeeeeeeeeeeeeeeeeeeeeeeee saaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaammmmmmmmmmmmmmmmeeeee aaaaaaaaaaaaaaaaaaaas wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwaaaaaaaaaaaaaaaaaaaakeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeTemperature Reguguguuuuguuuuuuuuuuuuuuguuuulallallaaaallalaaalalatititititititiononononononon HHHHHHHHHHHHHoooooooooooooooooooooooommmmmmmmmmmmmmmmmmmmmmmmmmmmmmeeeeeeeooooooottttttthhhhhhheeeeeeerrrrrrrmmmmmmmiiiiiiiccccccc PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPooooooooooooooooiiiiiiikkkkkkkiiiiiiilllllllooooooottttttthhhhhhheeeeeeerrrrrrrmmmmmmmiiiiiiiccccccc

Penile Tumescence Infrequent FREQUENT

DDDDDDDDDDDDD

How Much Sleep Do We Need?

Sleep is Vitally Important...

1. For all human functioning

2. Cognitive & physical performance

3. Its restorative powers 4. Learning & memory consolidation

5. Mood enhancement

6. Protects the immune system

7. Recent evidence shows a relationship to weight gain and aging

Institute of Medicine Report

“An Unmet Public Health Problem”

“The cumulative effects of sleep loss and sleep disorders represent an under-recognized public health problem…

Almost 20 percent of all serious car crash injuries in the general population are associated with driver sleepiness…

Hundreds of billions of dollars a year are spent on direct medical costs related to sleep disorders such as doctor visits, hospital services, prescriptions, and over-the-counter medications.”

The Extent of Sleep Deprivation

1. The average American sleeps less than 7 hours

2. 37% of adults say they are so tired during the day it interferes with daily activities

3. 75% of adults experience at least one symptom of a sleep disorder a few nights a week or more

4. 55% of adults nap at least once during the week

Source: NSF Sleep in America Polls

The Effects of Sleepiness and Fatigue

1. Impaired reaction time, judgment & vision (including Errors of Omission and Errors of Commission)

2. Problems with information processing & short-term memory

3. Decreased performance, vigilance & motivation

4. Increased moodiness & aggressive behaviors

5. Increased “microsleeps” – brief (2-3 seconds) sleep episodes

Sleep Loss-same as a DUI?

17 hours sustained wakefulness produces performance impairment = 0.05% BAC

24 hours = 0.10% BAC (Dawson & Reid, 1997; Williamson & Feyer, 2000)

People with mild to moderate untreated obstructive sleep apnea performed worse than those with a 0.06% BAC (Powell, 1999)

On 4 hours sleep, 1 beer can have the impact of a six-pack (Roehrs et al., 1994)

Sleep Loss & Memory Loss - Linked? The Glymphatic System

The Glymphatic Clearance Pathway is a functional waste clearance pathway for the Central Nervous System. It is like the body’s lymphatic system and named after glial cells of the brain which surround our neurons. During deep stages of sleep, this sewage system kicks into high gear.

One of the substances washed away is called beta-amyloid which is one of two core proteins whose build up is thought to contribute to Alzheimer’s Disease. The Glymphatic System is a

function of the sleeping brain!

Why We Are Not Sleeping…

1. Volitional sleep deprivation (work, lifestyle)

2. Poor sleep habits

3. Circadian factors (shift work)

4. Environmental disruptions

5. Untreated sleep problems/disorders

We Do Not Take The Need For SLEEP Seriously!!!

Alertness Strategies

Recognize signs of fatigue

Be aware of circadian factors (post-lunch dip)

Avoid building a sleep debt

Be aware of sedating medications – use alternatives if available

Take “Power Naps” (20 minutes in late morning/early afternoon)

The Foundational Pillars of Health

1.Exercise

2.Diet

3.Sleep

1.Regularity- how consistent is your sleep schedule?

2.Continuity- Is your sleep fragmented?

3.Quantity- How much total sleep are you getting?

4.Quality- Are you protecting the sleep process?

3 Pillars of Good Health 4 Pillars of SLEEP

The Spectrum of Clinical Sleep Disorders- not just Obstructive Sleep Apnea (OSA)

1.Sleep-Related Breathing Disorders

2.Insomnia

3.Circadian Rhythm Disorders

4.Sleep-Related Movement Disorders

5.Hypersomnia

6.Parasomnias

Sleep and Health- Summary

1. Sleep is a basic biological need that is essential to our health, performance, safety & quality of life.

2. Sleep deprivation has serious negative consequences, especially for shift workers

3. Signs & symptoms of sleep difficulties need to be identified & discussed with a doctor.

4. Establishing healthy sleep practices prevents sleep problems & promotes optimal sleep.

For more information visit www.sleepfoundation.org